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In an effort to bring attention away from misinformed memes and joke posts toward those rare good things being made about OCD, we’re starting a new series that will highlight movies, books, podcasts, and anything else.

In the case of the documentary film UNSTUCK: An OCD Kids Movie, those people are, of course, kids. An estimated 1 in 200 children has OCD in the United States, and the brief but moving UNSTUCK puts six of them in front of a camera to take you through their journey, from the extremely confusing first symptoms through their eventual diagnosis and treatment with Exposure and Response Prevention.

Vanessa showing part of her plan for exposures

The movie begins with Vanessa, who stands out as especially self-aware even in this group of six young people who never miss a beat. The voice of director Kelly Anderson prompts Vanessa to introduce herself. Vanessa says she’s ten years old and lives in Brooklyn, New York. Then, pausing for a second and leaning back in her chair, Vanessa says, “And I have OCD.” It’s the first sign of many that these kids have come to accept their obsessive-compulsive symptoms as part of their daily reality.

But how did that reality look before those symptoms were recognized as OCD? The film, adopting its pattern of cutting between brief interviews with each of its six stars, gives them a chance to tell us. Holden’s obsessions had him convinced he would suddenly become a bodybuilder if he interacted with anything related to bodybuilding or strength. The avoidance spiraled: he couldn’t look at the Hulk, which meant he couldn’t wear the color green; if he saw a strong character in a cartoon he would have to blink or breathe in a certain way and then turn off the TV, which would be contaminated from that point on. As Holden tells it, “And then I couldn’t use any of the electronics. So I literally just sat around all day.”

Holden and his sister Tatum talking about difficult times

The whole family gets involved

Some of the most compelling moments in this documentary are when the kids talk about how their symptoms gradually roped in their entire family. Jake tells us his parents would try to discourage his rituals by doing his chores, hiding things from him, and otherwise enabling him to avoid the emotional distress that would normally lead to compulsions. Jake says, “I felt really bad for them, because they were basically stuck in the rituals with me.”

Sarah, who remembers feeling like her conscience was telling her that things had to be just right, would ask her parents to say or do things repeatedly until they felt perfect. She reveals another tragedy of being a young person with OCD: “And at that time my parents didn’t know it was OCD, so they thought it was just me being disobedient. And so, yeah, it was hard.”

Charlotte, Sarah, Ariel, Sharif

Most powerful are the scenes when other family members are brought on camera. In one of these, Vanessa and her sister Charlotte sit across from one another. Charlotte looks at her intently, and Vanessa asks, “What do you think the hardest thing was?”

Charlotte replies, “Well, at first the hardest thing was you didn’t tell me about it. I didn’t even know something existed called OCD. It was also very hard when you were kind of a little afraid of me.” She explains that her frequent stomach aches made Vanessa avoid her out of fear she might get sick. Then she continues, “It’s kind of like, what did I do to make her feel like this?”

Demonstrating as always an impressive amount of maturity and self-awareness, these kids keep getting straight to the point about what’s so difficult about mental health conditions, whether you’re the person who has one or someone who cares a lot about them. The camera lingers on them just long enough after each statement, but keeps us moving quickly through the six stories until the film’s twenty-two minutes have suddenly slipped away.

Jake hard at work drawing a past self, stuck in compulsions

Getting better

Their first forays into therapy don’t go too well. Ariel, whose mom surprised her by taking her to see a psychologist one night, says, “I was just really upset from my mom taking me there. I didn’t want to talk to her about anything. I didn’t want her to think I was crazy.” She’s touching on one of those key barriers to treatment that we often forget to consider: wanting your clinician to see you in a certain way. Sharif was skeptical: “How can she know anything better than I do when I’m the one that’s been coping with this?”

But then, in various ways, each of the kids found treatment that worked. They all talk about this process, and part of the educational value of this movie is hearing them discuss when they learned what OCD was, how they were taught to see their thoughts differently, and what did or didn’t work for them. Jake started out in a group, where he learned that other people had similar symptoms. Ariel started out doing intensive treatment six hours a day, but quickly got better. And Sharif began purposely doing things imperfectly until he could habituate to the anxiety. There’s a wealth of information about each person’s hierarchy and exposures, but the film does seem to rush the part about treatment a little bit. It would have been interesting, for one thing, to hear from the same siblings again about how treatment ended up making things easier.

One thing that really stands out near the end is Vanessa saying, “I don’t think it ever really goes away. It’s always in you. It can just happen out of nowhere, where you’ll just get a blast and you just kind of have to work through it.” I’m not sure whether or not OCD forces kids to become wiser a lot younger than they normally might, but this kind of readiness to accept life’s difficulties without lashing out at them seems pretty uncommon among ten-year-olds.

“Learn about overcoming OCD from the experts”

Ariel showing us some highlights from her treatment binder

The filmmakers’ most important choice, and the crux of the film, is to reposition the six kids as the real experts. In most mental health media, the patient perspective is entirely absent. When it’s not absent, it feels canned or at least formulaic as people feel compelled to talk about their experiences in the same narrow terms, over and over. This creates a vacuum for people who are trying to figure out why they’re struggling so much and only finding the same old ideas everywhere.

As for the usual experts, there’s a ton of content out there from clinicians and researchers, and that stuff is always important. But we don’t hear often enough in unfiltered terms about mental health from the people who have struggled with it. This is especially true of kids, whose experiences tend to get trivialized or silenced by parents whose worry comes to eclipse their own.

By leaving the explanatory work to the kids instead of always cutting away to a team of experts, as most documentaries would, UNSTUCK gives us the clinical background and the real personal stories all wrapped into one. We get mental health in motion, not in the controlled environment of a research study. The movie is clearly informed by all of the necessary science, and a few clinical advisors appear in the credits, but the experiential stuff never feels dominated by clinical concerns.

It’s refreshing to hear these precocious young people courageously examine their own journeys, but this doesn’t mean the movie is full of unstructured venting about how hard it is to deal with OCD. Even more common than the overly clinical stuff about OCD is the kind of disorganized, repetitive internet content that never seems to lead anywhere. UNSTUCK stays away from this the same way it stays away from being too cold and clinical: by trusting the kids to relay their own stories, instead of imposing certain lessons or motifs (these emerge naturally as similar symptoms and treatment decisions are discussed).

The kids are insightful and well-informed, and have a well-earned sense of humor about their own symptoms. Sometimes the amount of clarity and honesty they bring to their assessment of how their behavior has affected them and their families is almost jarring; it makes me wonder why it took so long for someone to make a movie like this.

Sharif taking some time to practice– even if practice never makes completely perfect

Final Thoughts

UNSTUCK is a moving and informative short documentary that will be a great help to anyone hoping to understand OCD, particularly in children and adolescents. If you want to teach other people about OCD and some of its many manifestations, showing them this movie would be a great choice. It’s also a great antidote to the endless toxic stuff about OCD across the internet and in our culture more generally. And as a supplement to reading clinical perspectives, it offers a much-needed experiential take on mental health.

If you’re worried about this kind of thing, there are parts of the movie that can be sad. You’re watching kids talk about emotionally trying experiences, so that’s sort of a given. But the overall tone is hopefulness, and it comes from a firm commitment to the belief that feeling better is quite possible.

As a self-help tool, this movie will help you understand OCD and will give you some hints about how to get better, but it isn’t a treatment method. This isn’t the goal of the film, but it’s worth mentioning that you shouldn’t go into it hoping your own symptoms will improve. At the same time, learning about other people’s struggles can be cathartic. It’s worth noting that the struggles that OCD creates for these kids are barely different, if at all, from those that adults with OCD face. This is not really, in the end, a movie about kids with OCD. It’s a movie that sees kids as the best spokespeople for what it’s like to have OCD, and it makes a powerful case.

The movie is available now for educators and groups, and will be released soon for everyone else. In case you haven’t seen them already, the trailersarecompelling. Here’s one of them:

The close attention evident in each shot of this film can be explained in part by the fact that both its director (Kelly Anderson) and its producer (Chris Baier) are parents of kids with OCD. Kelly and Chris began to work on the film after meeting at a support group in New York, and clearly carried their determination to help their own children into their work on this film. Their care in bringing awareness to a disorder affecting hundreds of millions around the world is admirable.

And then we have the real stars of UNSTUCK: the eight young people (six with OCD and two siblings) who bravely tell us about all aspects of life with obsessive-compulsive disorder. You can’t watch this movie without admiring how they’ve responded to their condition by learning about it and committing to dealing with it differently.

Be sure to keep an eye on the film’s website for updates on how to watch it as an individual. If you’re lucky enough to catch it at a festival or community screening, let us know what you think. You can also check out UNSTUCK on Facebook.

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In a way, it seems like anxiety and depression should be opposites: one makes you way too revved up about things, and the other leaves you completely unable to care. This would be comforting for many, because you’d only have to deal with one set of symptoms at a time. Unfortunately, it’s far from the truth. Anxiety doesn’t always rev you up, and depression can make you care a lot.

There’s a whole lot of anxiety mixed into depression, and depressive symptoms are very common in people dealing with anxiety. In fact, the rate of comorbidity– one person having both disorders– could be as high as 60%. And, as we’ll find out below, the two aren’t so different at all. You might think of anxiety and depression as a venn diagram… one with very weak lines dividing it.

The Diagnostic Dilemma: What’s what?

The idea of mental illness is a tricky one. What really separates someone who’s been diagnosed with a mental health condition from everyone else? In certain cases it seems more obvious: when someone is psychotic or manic, or has become so depressed they cannot leave their bed, there must be something wrong. But most of us live pretty close to the boundary between “normal” and “in need of treatment.”

We can take the mental illness debate up at a later time, but for now let’s assume that someone is seeking treatment because they’ve been feeling bad for a while. They go to a psychiatrist, psychologist, or social worker who asks them a bunch of questions, listens for an hour or two, and then provides a diagnosis by matching up what they’ve said with the criteria in a big book of psychological conditions called the DSM-5. (In the United States, at least.)

A. 1. Depressed mood most of the day, almost every day, indicated by your own subjective report or by the report of others. This mood might be characterized by sadness, emptiness, or hopelessness.
2. Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day.
3. Significant weight loss when not dieting or weight gain.
4. Inability to sleep or oversleeping nearly every day.
5. Psychomotor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

As you can see, there’s a good amount of overlap between the two. Both cause a wide range of physical and emotional symptoms that range from being significantly slowed down to really revved up. Neither side of the spectrum is pleasant, but it’s notable that two different disorders have many of the exact same effects.

The point of all this? Diagnoses are always best guesses, not exact matches. Anxiety and mood disorders have a lot in common, so if you’re feeling lethargic and down but you also worry a lot you might receive both diagnoses to account for the slight variation. That doesn’t mean mood disorders don’t already involve worry most of the time– of course people become worried when they can’t enjoy most things or they’re having thoughts of suicide.

A few key symptoms can push clinicians in one direction or another, and many disorders like OCD have much more specific criteria. But other than that it’s more about trying to get at what’s bothering you most– and this often means offering multiple diagnoses in order to explain any symptoms you have that aren’t included in your primary diagnosis.

Psychological Crossover: What does research tell us?

The many similarities in diagnostic criteria offer one possible explanation for why so many people are diagnosed with both anxiety and depression, but there are other possible reasons the two tend to co-occur.

One study from 2015 looks at different psychosocial models for anxiety and depression. In one model, called the Avoidance Model of GAD, worrying is “a poor attempt to solve problems and deal with a perceived threat while avoiding the aversive somatic and emotional experiences that occur when confronting the feared stimulus.” In other words, when you worry you’re trying to fix some situation without dealing with the difficult parts of that situation– how it makes you feel, either physically or emotionally. Because you’re not going through those feelings, two things happen: the anxiety itself is reinforced because it helped you get off easy, and you don’t develop the ability to process the feelings involved. You become more likely to avoid similar situations, and to use anxiety as a way of doing so.

And one possible model for depression, the study says, is behavioral activation. This model suggests that depressed people avoid activities that might bring about positive feelings; in doing so, they end up more depressed and even less likely to seek out positive events. It’s easy to see how this vicious circle would perpetuate itself and make it increasingly hard for depressed people to experience any positive feelings at all.

Although the author doesn’t explicitly make this link, it makes sense to compare the models for anxiety and depression. If anxiety creates avoidance, and avoidance can reduce mood quality, we can easily see how the two would feed one another. Further, the negative feelings associated with depression are obviously undesirable, which means most people would try to avoid them in one way or another. One way is to worry about the negative feelings you’re encountering, instead of trying to accept them. In this scenario, reduced mood quality might encourage people to worry more, because it feels like you can “figure out” why you’re down and avoid the unpleasant feelings altogether.

These are only a few quick examples, but the bigger point is this: when you feel bad in one way, you’re likely to try to fix it. Sometimes “fixing” anxiety leads to depressive symptoms, and vice versa. Plus, anxiety can get so discouraging that we become depressed. And when we feel depressed we’re more likely to worry about ourselves, others, and the world.

Smarter Solutions: Feeling better with both depression and anxiety

The good news? In many cases, the best treatment for anxiety is also the best treatment for depression.

Anxiously avoiding some experiences because of depression? That avoidance isn’t going to help either the depression or the anxiety, so while it might feel extremely difficult in the short term, make a plan to participate in experiences and stick to it, no matter how depressed or anxious you feel. This is what many therapists call behavioral activation– doing more things now, so your mood can follow.

Feeling like you’re trying to worry your way through unpleasant feelings instead of just experiencing them? This is a really tough one, but mindfulness and acceptance exercises can help with both the worry and those unpleasant feelings. It’s understandable that you’d try to figure out why you’re feeling bad and make it better, but you’d do well to let go of the belief that worrying is going to help you get there. It’s just going to make you feel worse. Stick to doing things you care about, even when you feel anxious or depressed.

Taking medication for depression or anxiety? With some important exceptions, most drugs used for either of these conditions are also used for the other. Sometimes doses need to be higher for anxiety, and if you find that a medication is making you either more anxious or more depressed you should tell your doctor right away. But for many people the same medications will help with both.

Feel like anything that helps your depression also makes your anxiety worse, or vice versa? This is pretty normal, especially when you’re just starting treatment. Maybe going out with friends really helps your mood but also makes you anxious because you’re trying to figure out what everyone else is thinking about you. Perhaps exposing yourself to a night alone at home is great for your anxiety but also makes your mood worse. Sometimes you do need to make choices about what must come first, and (if you have one) your therapist or doctor can help you make those decisions. Other times, the negative effect will only be temporary. If going out with friends is usually making you really anxious, that anxiety sounds like something that could benefit from treatment too. And avoiding the event that makes you anxious will only reinforce the anxious avoidance, making you worse long-term.

Let’s look quickly at a few major points:

Lots of people who have anxiety also have depression, and vice versa

Because of diagnostic similarities, it can just take a few additional symptoms to receive both diagnoses

Whether or not they’re really two distinct things, anxiety and depression can feed one another in a number of different vicious circles

Sometimes treating one will treat the other, even when it feels bad short-term; other times, you’ll need to be more careful with your treatment and work closely with your clinician.

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When I was in junior high school, one of my best friends lived across the street. He always had the latest video games, his parents were more easygoing than the other adults I knew, and he had younger siblings to boss around– something that fascinated me, because I was the youngest in my extended family.

We’d flop down on their massive couch and watch a bunch of TV while his little brothers and sister came over and smacked us with various objects. Their house was so different from mine, and when I’d had enough of the chaos I could cross the street and go home to be the youngest again.

One night nobody else was around and we were watching reruns of Man vs.Wild, wondering why Bear Grylls would sleep inside dead animals if he didn’t really have to. When the episode ended, another show started right up. I don’t remember what the show was, but it was about someone caught in the wilderness who ended up cutting herself with a knife. I had no idea why anyone would do that, and the show was making me really uncomfortable. Not wanting to say anything to my friend and reveal my fear, I got up to grab some water from the kitchen.

I started to look around while I waited for the glass to slowly fill. Next to the fridge was a counter, and on the counter was a big block of kitchen knives– I had never noticed those before. But now they were the only full-color objects in a room that had gone black and white. I thought: I should grab one of those knives and use it to hurt myself. I was suddenly in more immediate danger than ever before; this wasn’t the half-tolerable fear that I’d felt while walking through haunted houses or playing drums in front of a crowd, but something more like complete fear, because now I knew that one of the things I feared most was bound to happen soon.

Heading back to the living room to avoid being asked what was wrong, I sat down and pretended to watch the show while a bunch of terrible thoughts and feelings filled me up. Everything mixed together: I tried to convince myself mentally that I would never grab a knife and do something like that, but then another thought about self-harm emerged and I felt even more ashamed, and the shame led me to thoughts like I’m so pathetic I might as well hurt myself like that. As long as I was having thoughts about self-harm I was convinced I might actually do it; and as long as I was convinced of this possibility I knew I needed to find a way to protect myself from myself.

When all of this only made me feel worse, I tried to insult myself away from the thoughts: What kind of sick person thinks like that? Don’t be so weird. This didn’t work, so I tried the old guilty thoughts: Imagine how disappointed my family would be if I did something like that. Any momentary replacement of this intense anxiety with slower, more familiar feelings like guilt and sadness was a welcome reassurance.

Eventually none of this worked and I ran away, across the street to my own house where everyone was asleep and there was also a knife block on the counter. Seeing that one didn’t help, of course, and by the time I’d run upstairs to my bed I felt like I had the flu. I hoped for morning to come, because it would mean I’d made it through the night without letting the thoughts take over; but I also couldn’t imagine facing my family in the morning, with this new knowledge that I might be the type of person who would harm myself with a kitchen knife.

At the time I didn’t know I had stumbled– thanks to a nice pairing of bad television and well-placed kitchen knives– across another manifestation of the the way my brain vastly overestimates the significance of thoughts I don’t like and gets stuck on them. I had no reason to suspect these thoughts of self-harm were anything but idiosyncratic: something that was wrong with me, and only me. Without any context, it was extremely difficult to place any limits on my thoughts, and so they took over.

If you’re feeling the way I felt then– no matter what the bothersome thoughts are about, and whether or not you have been diagnosed with OCD or are even interested in a diagnosis– knowing a few first steps toward feeling better can be really helpful. So, enough of my story; on to yours.

1. Notice what’s been happening

As soon as you’re able to take a step back and shift from engaging with your thoughts to noticing your thoughts, you’ve made one of the most important moves. Here’s the key: OCD recovery is never about getting rid of certain thoughts. It’s about changing your relationship with those thoughts. It’s hard to accept at first, but you will always experience thoughts like the ones that bother you now. What’s yours to change is the way you react to them– and, ultimately, whether or not they bother you much at all.

First you’ll need to identify patterns in your thought and behavior. You might notice that you’re always fine until a certain thing happens, or that every time someone says this specific thing you find yourself behaving differently from those around you. It’s not always great to use comparison with others as a primary method of gauging yourself, but in OCD recovery it can be helpful at times. When you’re the only one doing something and it’s making your life more difficult, it’s probably one of the things you could work on.

You’re looking for a few things: what sets you off, what thoughts and feelings arise when you’re set off, and how you respond to it. Don’t worry about how you’re going to fix things yet. Just observe, track, examine, notice, etc. If it helps to write things down, do that too.

2. Learn to recognize what’s what

Contrary to popular depictions, people with OCD aren’t bothered by everything. They might also be generally anxious, or especially sensitive, but obsessive-compulsive disorder is not a generalized tendency to be uptight about things. That’s why people can have OCD and still use a public restroom without washing their hands after, or constantly forget to clean up after themselves.

Only you know what really bothers you– and with untreated OCD we’re not talking about being kind of bothered by something. Usually the obsessions will revolve around one or a few themes: every time you’re near train tracks, or each time you’re with kids, or whenever you’re with your significant other and you walk past another couple, and so on.

Think of these as your triggers. What do they trigger? Usually an intrusive thought: I could jump on the train tracks, I could hurt these kids, Isn’t that couple more attractive than us? This intrusive thought, together with the ones that follow, form the obsession. Am I the type to hurt kids? I might be the type to hurt kids. Am I similar to other people who hurt kids? I heard a story about this person in my town who hurt some kids and we have some things in common.

The easiest way to tell obsessions from compulsions is that obsessions increase the amount of anxiety you feel. Compulsions are an attempt to decrease the amount of anxiety you feel. Although compulsions do backfire sometimes, if you’re doing something to get rid of anxiety caused by an obsession it’s probably a compulsion.

Compulsions come in many varieties: repeated actions like counting or touching things in the same order, checking, reassurance-seeking behaviors like asking other people or using Google, mental behaviors like thinking through things or reassuring yourself, and avoiding situations altogether.

Often people with OCD already know that their compulsions are strange or don’t make any sense but don’t know how to stop. But they don’t know that they can let down their guard and stop with the compulsions because they haven’t seen their obsessions for what they are: thoughts that don’t require any more attention than all those other thoughts we get throughout each day.

3. Behave differently to make the thoughts less scary

As you’ve probably noticed, arguing with your thoughts isn’t going to make them go away. In fact, this type of self-argument often becomes a compulsion in itself. This stuff doesn’t work because in most cases obsessions latch onto things that are fundamentally uncertain. Your brain is looking to be certain you won’t get sick, but you’ll never have that certainty. In fact, nobody ever lives a single day sure that they won’t catch a deadly illness. So you’ve got to stop trying to achieve a certainty that’s in fact impossible to reach.

This applies to all those other obsessions too: could you one day lose control of your own mind and jump on the train tracks, hurt some kids, or use a kitchen knife to hurt yourself? Is it possible that you might leave the stove on accidentally and cause injury to others? Yes, of course, because life is vulnerable and uncertain, and your brain can never change that. You’ll end up exhausted, frustrated, even panicked, and everything will still be uncertain.

So what can you do? Change your behavior in response to these thoughts and you’ll find that they begin to shrink. They won’t control you any longer, and eventually you’ll look at them every time they appear with only a vague memory of how much they used to bother you.

But it will get harder first. If you change your behavior and eliminate compulsions, you’ll still have the thoughts and all the bad feelings they cause in you. You’ll really want to use one of your compulsions to tap out and just be done with the pain, but in order to get to a point where the thoughts are just thoughts you’ll have to stick with it, finding different ways to keep yourself from using a compulsion. And only by making it through this pain without using a compulsion will your mind and body learn that they can tolerate uncertainty. Your brain can only be in distress for so long before it starts to habituate and realize that it’s alright. The tough part is that you’ve got to “sit through” this distress and let the habituation happen.

I’ll be writing more soon on specific strategies for staying away from compulsions, but these first steps are a good start. The main takeaway: OCD recovery is not about getting rid of thoughts, but about giving yourself a chance to learn how to tolerate them.

Please feel free to share with anyone who might find this helpful. Thanks as always for reading!

Note: This story talks about thoughts of self-harm. Even though this exact uncertainty is a key part of self-harm obsessions, if you suspect your thoughts might cross over into actual self-harm please contact a professional (like a therapist or your doctor) so they can assess your symptoms and help you make a plan. If you’re already engaging in self-harm, please get in touch with a professional immediately. And if you’re ever considering suicide, please call 1–800–273–8255,or your local suicide hotline if you live outside the US.

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Because it’s daunting enough just to understand the state of mental health in your own country (or even your town), we often lose sight of the fact that people are struggling with similar issues all around the world. To make sure we keep everyone’s mind in mind, here’s an infographic about the effects of OCD across the globe.

We’re looking for stories from people dealing with OCD around the world. If you live outside the United States and are interested in having your story featured on our social media accounts, or even writing a guest blog post, please let us know by messaging @treatmyocd on Twitter, Instagram, or Facebook. Thanks for your willingness to tell us about your life.

Also, whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together to improve their mental health looks like, feel free to check out the nOCD website for more: https://www.treatmyocd.com/patients.html

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Don’t like marker lines left over on the whiteboard when someone erases it?
Need to have your books in a certain order on your bookshelf?
Never really like to touch a toilet seat in the public restroom?

Because so many people say this kind of stuff, it can sometimes be hard to tell what people mean when they say “I have OCD.” Is it a serious statement meant to let you in on their own troubles, or another offhanded attempt to explain away their behaviors in a vaguely self-deprecating way? I once saw a roommate move in with a bunch of cleaning supplies and mentioned that I was glad to be living with someone else who did a bit of cleaning now and then. He responded, “Yeah, well I have OCD.”

OCD is like the Boy Who Cried Wolf of mental health conditions: so many people claim to have it that it’s lost its original meaning.

Why are OCD jokes offensive?

I still don’t really know if my roommate was serious, or trying to make a joke. Joke isn’t always the right word for people’s remarks about OCD– they’re often more like offhanded statements by a person who doesn’t have OCD using the condition as an excuse for some personality trait or behavior. But I’ll keep calling them jokes anyways for a few reasons:

They’re based on a failure to understand OCD

They’re usually meant to create a sense of good-natured or chummy connection with the person they’re being told to

Some people find them funny, others find them offensive, and still others don’t really find them either funny or offensive

Of course, people make OCD jokes because they don’t really understand it, not because they’re evil. The sad reality is that people rarely take the time to really understanding something unless it affects them or someone they care about. People also make jokes about mood disorders (“Sorry, I’m a little bipolar today”), eating disorders (“She’s looking a little anorexic”), and everything else. But still, OCD is still the subject of a disproportionate number of jokes about mental health conditions. Why are there so many jokes about OCD?

Actually, before we proceed, it might make sense to quickly address why people with OCD might be offended by these jokes and joke-like statements. One problem is that offhanded statements about OCD gradually make people less likely to acknowlege that it’s a serious, chronic condition affecting 1 in 40 adults and 1 in 100 children in the US. As I mentioned above, constant jokes about OCD make it unclear who is really in need of help and who is just messing around. They also make it harder for people to know what OCD really is, meaning they might be less likely to seek help even when they’re really suffering. People who are already in treatment feel even more alone because it seems like other people could never understand how bad they feel. Lastly, offhanded remarks can erode what little cultural understanding there is of OCD, making it more likely that people will make jokes, and so on.

Why are there so many jokes about OCD?

When the average person thinks of OCD, they think of two things: neatness and fear of germs. These depictions aren’t wrong, exactly, because many people with OCD do have these symptoms. But TV shows, movies, and the internet pick up on these compulsions without investigating the obsessions and the intense distress that lead people to use those compulsions. And OCD symptoms are much more varied than these stereotyped images suggest.

The behavior itself might seem kind of funny: okay, there’s someone washing their hands over and over, and we don’t know why. There’s another person who spends the entire day cleaning the same surfaces over and over. But once you know that they’re doing these things because they feel sure something bad will happen if they stop, it becomes less humorous.

For a very short summary, obsessive-compulsive disorder (OCD) makes it very hard for people to tolerate certain forms of what we call intrusive thoughts: those unwanted thoughts that pop into your head throughout the day. People with OCD feel unable to move on from the thought, and might start to ruminate about it. The result of getting stuck on intrusive thoughts is what we call an obsession. Most people have certain “themes” of thought they always get stuck on, like the possibility of getting sick or harming someone else. Because the obsessive stuff causes a lot of distress, people with OCD will often turn to a compulsion in order to reduce that distress.

Sometimes the compulsion is directly related to the obsession, and other times it isn’t. For instance, a person might wash their hands repeatedly (compulsion) because of thoughts about how they must’ve touched contaminated surfaces recently (obsession). In this case, the two are directly related. But they might also wash their hands repeatedly (compulsion) because they’re having thoughts about how they could’ve unknowingly run someone over on their way home from work (obsession) and the hand-washing relieves the distress the obsession causes.

You might say: okay, I would never make a joke about someone who fears they’re going to die of a serious illness, but what about the people who just like things to be really neat? This is another important point: the type of OCD someone has does not determine the amount of distress they feel. It seems like a pedophilia obsession would be more difficult to tolerate than a religious obsession, but there’s no equation for the amount of distress someone will experience. Besides, as mentioned above, the type of obsession and the particular compulsion often aren’t a clear match. Someone persistently reordering their books might be doing that to avoid how terrified they feel in response to an obsession like: I could go over there and suffocate my child.

With all of this in mind, here are a few theories about why there are so many jokes about OCD:

Obsessions are mostly invisible, so people only see the (sometimes strange) coping mechanisms used to dispel the distress they cause. Unfortunately, most people aren’t taking the time to wonder why someone would behave compulsively. Instead, they observe the behavior and it makes them uncomfortable so they tell jokes.

An “obsession” in our wider culture has a different meaning than an obsession in OCD. More widely, an obsession is simply something we’re intensely interested in. People with OCD are not “interested in” their obsessions, and would do anything to get away from them. Others might hear “obsession” and think that those with OCD have some say in what they’re obsessing about. But people with OCD aren’t obsessed with Rihanna; they’re usually very anxious about important aspects of their lives.

People assume that certain types of OCD must be worse than others, because the content of the thoughts themselves seems worse. They might know not to make jokes about “more severe” types, while also assuming that people with less severe types are somehow fine with being joked about.

Perhaps the most important takeaway is this: people are always engaging in compulsions in an attempt to reduce their level of distress. Nobody enjoys washing their hands over and over, and nobody wakes up saying “I’m glad to spend another day forcing my family to put stuff back exactly the way they found it.” It’s pretty simple: people with OCD are often in a ton of pain, and making jokes about people in pain is sort of messed up.

That leaves the offhanded remarks about having OCD. If you’re not feeling a crippling amount of anxiety before you do the behavior, and if you haven’t found yourself doing it before, it’s probably untrue that you’re doing it because you’re “a little OCD.”

You can help reduce the negative effect of OCD misconceptions by spreading good information around the internet, and by educating your friends and family when they say something like “I’m just so OCD about my furniture.”

By the way, if you ever hear someone who’s truly struggling with OCD say something like these…

I’m so OCD
I’m a little OCD
It’s one of my OCD things
That’s such an OCD _____

…Then please let us know, because we will be very surprised.

Until next time,

Patrick
The nOCD Team

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Have you ever wondered how to help coworkers or employees with OCD? Felt hopeless watching people perform compulsions or hide their symptoms in the office because you didn’t know what to do? Here are some important facts, and ideas of what to do with them.

Thanks for reading, and until next time!

-The nOCD Team

Whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together on their mental health looks like, feel free to check out the nOCD website for more: www.treatmyocd.com

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Whether you’ve been following us on social media for a while, found out about the nOCD app from a friend, or just stumbled across our blog, you might be a bit confused about what nOCD is and where it came from. We’ve already covered some of the basics in our post about the nOCD team, but we’d like to give you a clearer picture of why all of this exists in the first place, and where it’s headed next.

Stephen grew up in suburban Chicago, playing football and frequenting the local Italian restaurants with his family. As a kid he sometimes suffered bouts of intense worry about becoming sick, or even getting cancer, but mostly things were fine. When he finished high school in 2012, things were looking up: not only was he heading to college in Texas, but he’d be the quarterback of their football team.

By the time he was a sophomore in college, Stephen’s anxiety had only gotten worse. His old compulsions of looking things up for reassurance– the old WebMD Symptom Checker trick that many of us know too well– were no longer keeping the daily worry at bay. He made it home for a break from school, and then his symptoms reached their peak. Stephen could barely leave the house, suddenly reduced from performing at his best to simply getting through the pain and making it to the end of each day.

In Therapy: Good Treatment Is Hard to Come By

The distress became so bad that Stephen felt he wouldn’t be able to stand it much longer, so he set out to figure out what was going on and get it treated. He looked online first, and connected with psychologists who told him he would just need to fight the thoughts, or maybe move away from home. These clinicians gave him a lot of advice, but nobody really taught Stephen any strategies for getting better.

Even once he finally secured an appointment with an expensive OCD specialist, Stephen didn’t learn everything he needed to know. And he found that the symptoms he experienced in between his therapy sessions could quickly become overwhelming. It was extremely difficult to complete ERP (exposure and response prevention) homework while already in the midst of a crisis, and an hour of treatment per week wasn’t enough to prepare for the 167 other difficult hours he would face alone.

The Solution: OCD Treatment on a Smartphone

Finding that there was nothing else out there, Stephen came up with his own solution: an application on his phone that would allow him to do ERP exercises and get help during an OCD episode, while tracking data on where he was when the symptoms hit, how severe the symptoms were, and how long they took to subside. His phone was always with him, and his friends never asked why he was using it.

While working on something for his own treatment, Stephen knew that it would benefit lots of other people who were struggling to get treatment for their OCD symptoms. The app would make it much easier, and much cheaper, for people to find treatment, stick with it, and get better. No longer would it take 17 years on average for people to even get the right diagnosis and start on what would likely be a long journey through OCD treatment.

From then on, Stephen has worked tirelessly to build the nOCD app and the community around it. But a big part of nOCD’s success has been Stephen’s decision to surround himself with other people who are driven to help people with OCD and highly skilled at what they do. Because around 1 in 40 American adults has OCD, most people have some association with OCD through friends or family. nOCD is no exception: all of its team members either have OCD themselves or know someone who does. And when you’re close to this disorder, it doesn’t take long for you to wish there were more ways you could help.

From summer 2014 through fall 2016, the nOCD team grew as Stephen invited people from around the country to take on different roles. While Stephen focused on meeting researchers, clinicians, and business partners, developers in California and Texas began helping him build the app from the ground up. From UI/UX design to concerns about cybersecurity, nOCD’s talented developers worked with Stephen over this period to get the app ready for release. Meanwhile, nOCD’s team of clinical advisors vetted the app to make sure it adhered to the same treatment standards they would use in their own practices.

Around the time the app was released in late 2016, we also began to focus more on bringing people of all sorts into our community. Through social media, a new website, and most recently this brand new blog, we’re working toward our goal of giving everyone a place to learn about OCD and mental health. At 80,000 people and counting we’ve already gathered the largest OCD community in the world, and we’re just getting started. It’s bad enough dealing with OCD, and people shouldn’t have to face the added nightmare of going through it alone.

We can see everything from up here!

A few months ago we moved to a brand new office in a tall building on Michigan Avenue in Chicago. We continue to add team members, allowing us to focus more closely on a bunch of things. Here are three of the main things we’re focusing on:

Continuously improving the nOCD app so it’s more helpful to everyone using it (Also: Yes! There is an Android version in the works.)

Growing our community around the world, and providing the best educational content so misconceptions about OCD fade and people realize it’s a common, treatable mental health condition and not an annoying personality trait

Partnering with more of the best, most knowledgeable people in mental healthcare, business, and tech so we can reach more people around the world and improve what we offer to them

Getting nOCD to where it is today has required constant testing, meaning we would still be at square one without all of our active community members like you who choose to get involved, offer feedback, and help us grow in the right directions. In other words, your constant support is the single most important thing we have at nOCD. Thanks for being a part of this, and for working hard along with us each day to make OCD treatment better for everyone.

Do you have any questions about nOCD or suggestions about what we could be focusing on? Please let us know in the comments!

Whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together on their mental health looks like, feel free to check out the nOCD website for more: www.treatmyocd.com

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What causes OCD, and how can we treat it?

Even though an estimated 70% of people with OCD find them helpful according to the IOCDF, both medication and behavioral therapy fail for many people. If you (or a loved one) haven’t experienced recovery yet, it’s possible that existing treatment methods haven’t been optimized for you. It’s also possible that the treatment you need… hasn’t been invented yet.

Luckily, there are tons of researchers out there working hard every day to find new treatment options for OCD. Some of these potential new treatments begin with attempts to understand the cause of OCD. Others ask: why aren’t the treatment methods available today working for lots of people? Let’s fly through a few new treatment developments and what they might offer for the future of OCD.

First, a new study from Duke University found that overactivity of one single type of chemical receptor in the brain is responsible for symptoms closely resembling OCD in mice. When researchers gave the mice something to block those receptors, their OCD symptoms let up in under one minute. Now, unless you’re a very smart mouse reading this, these findings don’t necessarily translate to an easy fix. But this provides hope that further research on the mGluR5 receptor could translate to better options for humans too.

Another recent study looked critically at two different options for augmenting, or adding to, first-line serotonin reuptake inhibitor therapy: the antipsychotic medication risperidone, and Exposure and Response Prevention (ERP) therapy. Researchers found that ERP was a more effective augmentation strategy, especially for younger people and those with more severe OCD symptoms.

Coming up next is a very recent study published by the Centre for Addiction and Mental Health. A few ambitious researchers found what seems to be a strong correlation between OCD symptoms (measured on the Yale-Brown Obsessive Compulsive Scale) and inflammation in the parts of the brain believed to be responsible for those symptoms. Though the amount of inflammation varies, this finding provides a basis for many possible treatment developments.

Ketamine, an anesthetic sometimes used recreationally, has been getting a lot of buzz as an emerging treatment for depression and other conditions. It’s now also in early trials for OCD, led by people like Dr. Carolyn Rodriguez at Stanford, and they’re getting promising results. As in the depression trials, researchers are still working to figure out how to reduce the side effects and extend the positive effects of ketamine.

Lastly, researchers around the world have been looking more closely at the role of glutamate, a neurotransmitter like serotonin, that they believe plays a role in the compulsivity part of OCD. One review looked at a number of drugs that act on glutamate and concluded that OCD is the best candidate of all disorders for successful treatment by glutamate modulators. As always, the study concluded that further studies will be needed to determine anything else.

We’ll be sure to keep an eye out for the latest on OCD research. And if you see or hear anything, please be sure to let us know in the comments.

Until next time,

The nOCD Team

If you’re interested in learning more about the nOCD app, a platform for treating your OCD and finding a community of other people dealing with anxiety disorders, check out https://www.treatmyocd.com/patients.html

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When I was in middle school, I regrettably had little appreciation for my mom’s cooking efforts. I would come home from school every day anticipating to see Mrs. Fields in the kitchen baking me cookies. This unrealistic expectation led to a series of disappointments and a decade’s worth of scoldings. I would often ask myself, sometimes out loud, “How hard can it be to actually make a good meal? It looks so easy.”

(Yum)

I realized years later that, in fact, it’s very hard to cook well, especially under the time constraints my mom regularly faced. My mom had the responsibility of feeding me and my four siblings: five equally obnoxious children who each had unique nutritional needs and taste preferences — and this was just one of her many responsibilities. When we offered unsolicited feedback on her food, although obviously frustrated, my mom listened, researched other recipes, and continuously improved her cooking until my house became known for its food.

Learning to design user-friendly software is similar to learning how to cook- it takes time. In fact, unlike in the movie Field of Dreams, “if you build it, they will most likely not come.” Just like someone learning to cook for the first time, beginner UX/UI designers often have little idea “where to start” when designing an interface, so they just use whatever design feels most intuitive, without doing much research. This often leads to blunt negative feedback, the kind that bratty kids give their parents who are trying to hone their cooking skills on top of a seemingly endless amount of other tasks.

#FieldOfDreams

We had a similar experience at nOCD two years ago when I started building our first UI. Because I didn’t know much about UX/UI design at the time, I created a design that I felt was intuitive, paid a firm to make it look more professional, and shipped it to our users. They hated it with a burning passion, as they expected the app to flow as well as other popular mental health apps like Headspace and Pacifica. I quickly felt a level of frustration similar to what my mom must have felt when my siblings and I gave her grief for her cooking ability. I put all my effort into making a product that I thought people would like, and they spat it back in my face with distaste. It was YEARS worth of work, verbally ripped to shreds in a matter of seconds.

The old nOCD app

I quickly realized I had to do something to avoid losing the company, so I decided to learn UX/UI design myself. I came to the decision while I was at my parents house eating a delicious bowl of chili that my mom made. I thought, “If my mom can learn to cook, then I can learn UX development from trial and error.” In retrospect, the challenge forced me to think through the problem intuitively. Here’s what I did:

1. I created a clean system for collecting “event” data and went through each of the app’s “event funnels”, to objectively understand how users navigated nOCD.

When building any kind of software, it’s crucial to have a clear system in place for collecting event data, since it will allow you to understand which screens get the most traffic and which ones don’t. For example, if you have an app and it logs 10,000 events on your first onboarding scene and 7,000 events on your last, then you can deduce about 30% of your users “bounced” in the onboarding flow.

Here’s the data from the testing period

Taking the time to establish a clean system for tracking event data enabled me and my team to learn about our users quickly- they simply weren’t coming back to the app. This data forced us to ask questions like, “Do we really need this one feature, if it’s not gaining traction? Is the current app providing enough value for our users? Is the app’s user interface too complicated?” From a high level, we noticed a deep UX problem, which required us to take a deep dive into our product.

2. I reached out to people with OCD in our social media community to better understand the problems they faced, in hopes of figuring out how to solve them and improve nOCD.

Finding “Product Market Fit,” the answer to premier UX, is not just about asking questions, it’s about asking the right questions in a manner that will engage your audience enough to reveal deeper levels of meaning. We came to this epiphany when we asked our users via Instagram, “If you could wave a magic wand and fix three things related to OCD treatment, what would you fix?” This question sparked a dialogue that encouraged people from all over the world to not only answer, but also support others who shared their story. From this dialogue, we realized the power of the question, as it revealed a need for people to talk and share their story, the real value proposition.

The Instagram post for feedback

3. I used Sketch to create multiple UI prototypes of a 24/7, in-app community support feature. Then, I created an Invision prototype to get market validation.

The Annotated Sketch wireframeThe Invision prototype

No matter how confident you are in an idea or a new direction, it’s essential to get market validation first using UI mockups. An idea is only an assumption, and making UI mockups is significantly cheaper and more efficient than coding it and releasing it to a user base. There are some phenomenal tools that you can use to build and test UI mockups, such as Sketch and Invision. In Sketch, you can design your UI mockups and easily export them into Invision, a free prototyping service that enables you to turn your mockups into a clickable prototype. After making a clickable Invision prototype, you can then show it to users or videotape yourself going through the flow in QuickTime.

For the nOCD community feature, I created the mockups in Sketch, dropped them into Invision where I made a clickable wireframe, and videotaped myself navigating the feature’s flow in QuickTime to show our user base the feature from a high level. Then we dropped this video into a Google Form, and got over 150 people with OCD to analyze the video and give pointed feedback. Over 90% of the respondents rated the feature a 9/10 or higher, and left incredible feedback. We then had data to support our assumption- proving that a community feature would enhance nOCD’s usability, allowing us to hand off the problem to our brilliant engineers. Our dev team implemented the UX enhancements, and now the app’s two-month retention rate is 25% higher than what it was prior to testing.

The UX mods helped nOCD become the largest online platform for OCD treatment in the world and the highest-rated platform for social cause by UX/UI Awards 2017. We still have a lot of work to do, but if I could thank one person for nOCD’s success outside of my brilliant team, it would be my mom, who taught me to summon the gusto needed to compartmentalize my frustration and improve. Might I add, she is now one of the best cooks around.